Making Primary Care a Primary Concern

Teaching hospitals are adding primary care residencies, but despite best efforts New Jersey still faces a looming shortage of primary care physicians.

In an attempt to ease New Jersey's shortage of primary care doctors, the state's teaching hospitals are increasing the number of residencies they offer in that discipline.

It's a necessary effort. But with fewer than 20 new positions all told, it's nowhere near to making a dent in the 1,500 primary care physicians needed in the state by 2014. That's when 600,000 currently uninsured New Jerseyans will be eligible for government-subsidized coverage under the Affordable Care Act -- and will start looking for doctors.

The ACA itself it helping with the problem. A five-year, $10.5 million grant is funding primary care residencies at Cooper University Hospital, Newark Beth Israel Medical Center, and the University of Medicine and Dentistry of New Jersey. And a $795,000 five-year grant to the Cooper Medical School of Rowan University will help ensure new students will begin their training by serving one day a week in the school's primary care clinic.

Dr. Thomas A. Cavalieri, dean of the UMDNJ medical school in Stratford, said expanding the school's primary care residency program will result in 10 more family practice doctors being trained in the next five years. Still, Cavalieri estimates that by 2020 New Jersey will be short about 3,000 doctors, and about half the shortage will be in primary care. He said that over the past five years his school has increased enrollment 50 percent, and now admits 150 students a year, up from 100.

Cavalieri aggressively recruits New Jersey students, who make up 85 percent of the student body. He also works with New Jersey hospitals to develop family medicine residencies. “There is a lot of data that suggests where doctors do their residency training, they are likely to practice,” and his goal is to encourage his students to stay in New Jersey.

That may be looking on the brightest side of things. According to the 2010 survey of graduating residents by the New Jersey Council of Teaching Hospitals, only 37 percent of New Jersey’s graduating physicians planned to establish their practice in the state last year.

“Our school is noted for its emphasis on primary care,” Cavalieri continued. “We have very excellent faculty role models in family medicine. One thing that influences the field you go into is this issue of mentorship. A great role model will attract you into the field.”

Dr. Paul Katz, dean of CMSRU, said studies suggest that as much as half the national doctor shortage that looms in 2014 will be in primary care. But he suggests the problem may not be solved all that easily.

“It’s a tough time to be a primary care physician.” Katz said. Specialists earn more, and that is a big factor when choosing a career—since doctors can easily rack up more than $100,000 in student debt by the time they begin practicing medicine for a living. “We can’t control the difference in reimbursements between primary care physicians and specialty surgeons. But we can introduce our students to what it means to be a primary care physician and the opportunities and joys associated with that, and do so very early in their careers."

Katz, like Cavalieri, believes that mentors can make a very real difference to primary care residents. One example: Dr. Jeff Brenner, who is on the staff of Cooper University Hospital and has a national reputation for the work he is doing as leader of the Camden Coalition of Health Care Providers, which is trying to improve preventative care in the city, and reduce reliance by Medicaid patients on hospital emergency rooms.

“Jeff is a great role model and advocate for primary care, and for service to those who most need it,” Katz said. The idea is for students to form relationships with clinic patients that continue throughout their four years in medical school.

“Primary care is a lot about relationships, about interactions that endure over time,” Katz said. “It has very little to do with care that’s delivered in the hospital but has a lot to do with care that’s delivered outside the hospital, in the clinic and in the home. We want the students to really understand the importance of paying attention to patient needs."

Cooper University Hospital is adding four primary care residencies this year.

Dr. Joshua Rosenblatt heads the residency program at Newark Beth Israel, which also received a federal grant that’s enabling the hospital to add two residencies each in pediatrics and internal medicine. All four are being funded for five years, and he hopes they will become permanent.

When these new doctors complete their residency “They will go out into the community and practice medicine and they will make a very big difference” in the availability of primary care, Rosenblatt said. The current shortage “can be seen in the emergency room, where patients who don’t have access to primary care elect to receive their care in the ER, which tends to be less effective” and results in patients developing medical problems that might have been avoided with consistent, timely primary care.

Hackensack University Medical Center is seeking state approval to reopen Pascack Valley Hospital in Westwood, and hopes to open a 128-bed hospital there next year. Dr. Ihor Sawczuk, chief academic officer at HUMC, said the hospital will start a new family practice residency program at Pascack Valley that will admit as many as six residents the first year, for a total of 18 over three years. “We view family medicine as a very important specialty -- we need to increase our teaching capacity to train the next generation."

Again, the challenge will be to get them to stay here, he said. To do that, “we can help them find jobs, help them open a practice or join another practice, and train them in business.”

New Jersey needs a strong primary care system “to pick up health problems before they get worse,” Sawczuk said.